Provider First Line Business Practice Location Address:
208B EAST CONCORD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-433-5550
Provider Business Practice Location Address Fax Number:
828-433-5256
Provider Enumeration Date:
07/24/2006